Dr. Scott J. Heun's ChiroThoughts Blog

An Open Letter to Our President

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Sat, 27 Jun 2009 16:39:00 +0000

Dear Fellow Chirpractors:

As we enter into this critical time of debate regarding the future of health care in our country, we must all participate. Every voice counts, if it is heard that is. Take a few moments to send a letter to the White House, and to your local representatives in the Senate and House of Representatives. Though I am optimistic about the contributions chiropractic will make in the future, regardless the outcome of the legislative compromises ahead, I believe we should help to frame the debate. We have as a profession contributed greatly to the health and welfare of our fellow citizens since 1895. I know we will continue to do so. However, we must have a voice in the national debate to have maximum impact at this juncture.

June 2, 2009

Barack Obama

President of the United States

The White House

1600 Pennsylvania Avenue NW

Washington, DC 20500

Dear Mr. President:

I am a second-generation chiropractor. I grew up personally witnessing the incredible benefits of chiropractic care in our community. My father the late Dr. Richard Heun practiced in Napa, California for nearly 40 years. In that time, thousands of people suffering from all sorts of physical ailments sought and received help from my father. This patient-centered approach to hands on health care inspired me to pursue a career in chiropractic as well.

I practiced in Pinole, CA for twenty years. My focus was on sports and spinal rehabilitation. I developed a multi-disciplinary clinic, incorporating the latest rehabilitation techniques with a team of professionals from other disciplines. We had great success in helping many patients regain their function and strength, to return to productivity, and to enjoy their lives again.

I have retired from practice, and now mentor chiropractors with the objective of developing clinical excellence, and mastering a patient-centered approach to practice success. I teach seminars and workshops, and counsel doctors throughout our great country, and in the UK, Australia and Japan. The profession is alive and well all over the world.

As you begin to implement your plans for health care reform, please remember the value my profession provides the public. We are the largest drugless healing art. We as a profession represent the third largest block of physicians in the USA. We provide a primary portal of entry in health care, the role of the “family physician” in many small communities. We are all well trained, and can integrate as part of a health care team, dedicated to helping our fellow citizens from a conservative health care perspective. For many ailments affecting the human frame and muscular system, we offer the least invasive, safest, and least costly solution available.

You have an ambitious agenda ahead of you Mr. President. I am sure you would agree that we all must contribute in order for our country to thrive. Chiropractors, and the profession as a whole can help you to shoulder some of the burden of caring for our citizens. However, we need you to include us in any and all proposed solutions in order to play our role and do what we are trained to do.

I wish you the best in your endeavors. I encourage you to let the chiropractic profession help you achieve your objectives. Thank you for your time, I wish you and your family the best.

Sincerely,

Dr. Scott J. Heun

Medicare or Medi-Scare?

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Thu, 14 May 2009 20:04:00 +0000

This excerpt was sent to me today in an email. It originated from Dr. Leonard from the Wisconsin Chiropractic Association.

Subject: Will Medicare Fire Chiropractic Based on OIG Finding?

Will Medicare Fire Chiropractic?

Attached is a copy of a report issued by the Office of Inspector General (OIG) on payments made to chiropractors for Medicare services. The audit’s findings were as follows:

Medicare inappropriately paid $178 million for chiropractic claims in 2006, representing 47 percent of claims meeting our study criteria.

Efforts to stop payments for maintenance therapy have been largely ineffective.

Claims data lack initial visit dates for treatment episodes, hindering the identification of maintenance therapy.

Chiropractors often do not comply with the Manual documentation requirements.

88% of the reviewed claims had inappropriate payments for “maintenance therapy”, 26% for undocumented care, and 6% for miscoded care. 20% of the claims had multiple errors. Separate from the undocumented claims counted as errors, 83 % of chiropractic claims failed to meet one or more of the documentation requirements.

In the past, when reports regarding the chiropractic profession have been required by Congress, the reports were inexcusably delayed. This report seems to have been issued at a time calculated to do maximum damage to the chiropractic profession – in the middle of the debate over health care reform.

If the chiropractic profession does not immediately and aggressively respond to the conclusions of this report, every one of our competitors will point to this report as an excuse to disregard the chiropractic profession as decisions are made on the benefits to be included or the reforms that are to be made in the health care reform bill.

We believe the report has a critical flaw in that its definition of “maintenance therapy” is discriminatory and it is nearly impossible to apply to a particular case via a review of chiropractic documentation.

The Medicare policy manual defines “maintenance therapy” as follows:

Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy. For information on how to indicate on a claim a treatment is or is not maintenance, see §240.1.3.

Discrimination

First, it is critical to note that Medicare has a different standard for chiropractors than it does for medical providers. Medicare routinely pays for the medical treatment of symptomatic chronic conditions including heart disease, rheumatoid arthritis, diabetes, macular degeneration, allergies, and many others. On the other hand, Medicare states that chiropractic adjustments “performed to maintain or prevent deterioration of a chronic condition” are maintenance therapy. For Medicare patients, medical treatment that keeps a chronic or degenerative condition from worsening is accepted; but it is a violation of the law for chiropractors to provide the same standard of care to their patients.

Definition of maintenance care

When a Medicare patient presents with another episode of a chronic condition, their chiropractor cannot know whether it is a new problem or an exacerbation of a previous problem until he/she examines the patient (which Medicare will not pay for). At this point, if the chiropractor determines the pain is due to an exacerbation of a previous problem, they are supposed to guess, based on the current deterioration of the patient’s spine, whether or not this treatment plan will fully resolve the problem because if it merely prevents deterioration of the condition to the point where, for instance, it might require expensive surgery, a chiropractor violates the law by providing care.

The chiropractic profession has never challenged this absurd definition of maintenance therapy. It appears to have been written by an individual without specialized knowledge of the needs of the elderly with regard to their spinal problems. The overwhelming percentage of Medicare patients who seek care from chiropractors are suffering from chronic conditions. If a chiropractor is able to document that acute symptomtology is present, these patients should not be viewed by Medicare to be receiving maintenance therapy.

Other problems

The OIG report also found that 26% of the audited claims had inappropriate payments for undocumented care. Clearly there should be no payment for chiropractic services when a chiropractor fails to document their clinical interaction with the patient. However, the basis for these determinations was opinions of reviewers hired by OIG.

OIG stated they “worked with the medical review contractor to select chiropractors with previous experience in reviewing chiropractic services provided to Medicare beneficiaries to serve as medical reviewers for this study”. The chiropractic profession is all too familiar with the bias of chiropractic reviewers who skew their opinion to retain their employment relationship. Without an unbiased review of the credentials of those performing this “review” work, the chiropractic profession should insist that an unbiased third party with impeccable credentials confirm the accuracy of these “reviews”.

Because time is of the essence, the response of the profession to this report needs to be widely disseminated to members of Congress and the Obama administration before our competitors seek to destroy our credibility in the negotiations over national health care reform.

Regards,

Russ Leonard
Executive Director
Wisconsin Chiropractic Assn
(608) 256-7023 Ph
(608) 256-7123 Fax

Praise and Recognition

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Fri, 08 May 2009 09:46:00 +0000

According to a survey published in USA Today, the way employees want to be acknowledged for their work may be different than our knee jerk reaction as to how they want to be recognized.

Take this "quiz".

Rank the following items in the order you think employees prefer.

Additional time off.
Cash bonuses.
Seminars or Training.
Verbal recognition.
A personal card or note.

What was your first choice? How about your second? If you chose the one most people choose, cold hard cash, you would be...
incorrect. In fact the 42% of those surveyed preferred verbal acknowledgement over additional pay! Cash bonuses came in at 19%. Followed by additional time off at 9%, seminars and training at 7% and cards and notes at 6%.

The moral of the story is, to verbally praise your team, when it is deserved of course, is the best way to give them what they want. In so doing, you will build the team morale, and drive success in your practice.

Implement the No Whining Rule...

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Fri, 06 Mar 2009 21:13:00 +0000

Dr. Scott J. Heun

If you want to improve the quality of your service, and grow your practice based upon referral, you must have a cohesive, dynamic and communicative team. This team must be involved in the organization, must be responsive to the needs of each person you serve, moreover contribute on a regular basis to improving the efficiency and quality of the service the practice provides the public. A regular interplay of ideas is required. However, whining is not allowed.

I instituted the "no whining rule" in my practice years ago. It solved a plethora of issues, and resulted in a much more dynamic and patient-centered team.

Here's how it works.

Every team member has an email account to be used specifically for inter-office communication. Be sure to amend your office policy to insure a secure and safe use of email from your organization. Be specific as to your rules and regulations. (If you do not have an office policy in place, write me at info@chiropracticementoring.com and in the RE: line write I need ChiroHire and Made-To-Fit.)
Each team member is instructed that whenever they make an observation of something that is problematic, they are to compose an email describing the issue in detail, and send this to the CEO (Chiropractic Executive Officer) and the team.
Here is what changes an observation from a whine, to a constructive and organization improving opportunity. Any observations must be accompanied by a proposed solution to the issue at hand, as described and noted from the perspective of the resident expert at that post...the observer noting the problem!
The CEO then assesses the impact of the problem, considers the proposed solution, and elects to adopt the recommendation, modify it, seek advice from the team, and then implement or reject the recommendation accordingly.
A printed copy of the observation and recommendation is kept in the team members personnel folder. Credit for contributions to the success of the practice organization and or growth of the practice directly or indirectly, deserve to be rewarded.

Every practice should be responsive to the marketplace, dynamic and intensely focused on customer service through ever improving efficiency. This simple solution applied, and acted upon provides the means to constantly improve your practice, with the ultimate result being improved service, as well as an improved bottom line.

Natural Childbirth...

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Thu, 05 Mar 2009 20:02:00 +0000

As many of you may know, I am a big fan of natural childbirth. All of my children came into the world with little or no stress. All the 5 living under my roof right now were born at home. My wife insisted. Without taking anything away from her, I also wanted to give an endorsement for having a supportive person on your team, a midwife or doula. Make no mistake, my wife was always in charge of the birth, I was there for support, and the midwife was there to support us both. Also, they were there to allow me to be a husband, and leave my doctoring credentials at the door. It was a wonderful experience each time. I recommend you consider using a midwife, or doula if that fits your philosophy.

Recently, one of my friends announced her new website. Have a look, and get to know her, she is a wonderful advocate for birthing women.

http://www.doulamoon.net

Guest Post: Dr. Joe Bowles

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Fri, 13 Feb 2009 20:32:00 +0000

I offer this bit of wisdom from my friend and colleague Dr. Joe Bowles. Enjoy,
SJH

Do you have the recession blues?

An “if the shoe fits” thesis by Dr. Joseph T. Bowles

For crying out loud my dear friends & colleagues, America can’t even seem to take a breath these days without someone on the tube, Internet or the radio being the prophet of financial doom. To this type of verbal behavior I have one thing to say, “Mule Muffins!” I clearly remember Dr. Carl Cleveland III making the following statement concerning the downturn in enrollment at the ‘other’ chiropractic colleges during a faculty meeting back in 2002, “at Cleveland we choose NOT to participate in that trend”. Maybe you noticed that he moved into a sparkling, well equipped $28,000,000.00 campus in the most posh area of Kansas City recently. That man doesn’t participate in negative trends and moves forward with confidence. He does not listen to the naysayers and prophets of doom. So, are you ready to move forward too? If so, all the more reason to turn off the TV, listen to classical music instead of the political/financial goobers on talk radio, filter out the junk of the Internet, stop listening to the chiropractic prophets of doom and only read something that will be uplifting to your situation….like this!!

Okay, time for class. Let me ask you another question. Is the practice down or maybe has it never been up where you want it to be? If one or both of those fit your situation, let me ask you another question. Whose fault is it? Let’s see…maybe insurance companies. Yeah, that’s what’s causing all the problems. Let’s get the ACA and ICA to join forces and sue these bums, so we can live in peace and prosperity. Or maybe it’s that the clinics neighborhood is changing. Or maybe it’s that people now see what you have to offer is a luxury and not a necessity. Or maybe people in your community just don’t get it. Or maybe you think you stink at getting new patients or running a business. Or maybe, or maybe, or maybe, or maybe, or maybe, or maybe ad nauseum. The answer is none of those or any other ‘physical’ things and here is a good example of why it is not those ‘things’.

My good friend, Dr. Dallas Humble and some other new DC’s once went to visit Dr. Lloyd Latch in San Francisco quite some time ago. He was the cagey veteran DC that had the whole sixth floor of a downtown office building. His clinic was packed and was consistently seeing well over 1000 patients per week from what I understand. I think it was more than this actually. Now Dr. Dallas is (like most of us) a skeptic but he saw it and said the numbers were no exaggeration. When Dallas finally got to speak to Dr. Latch he asked the following, “Lloyd, I have one thing to ask, where do all these people park their cars?” Dr. Latch paused a moment then responded, “gee….I never thought about that….I guess I would have if I had been in the parking lot business.” This should partially illustrate that the real ‘fault’ lies within our own minds when things are not going our way. Whether he knew it or not, Dr. Latch understood the content of the following scripture from Ephesians 6:12 and was in complete control of his situation. “For we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places (our minds).” So my friends, the source of the problem with having a lack of growth or stability is between our own ears and no other place. We are in a war of ideas and the greatest battle ground is definitely in our own minds.

To this you might say, “well gee wiz Joe you haven’t been out there lately.” To that I respond with a very blunt, “so what.” Hey doughboy, the struggle has always been the same regardless of the era in which someone lives or practices. I began practice on July 15 of 1978 in the swarthing megalopolis of Union, Missouri, population 5500. Jimmy Carter was president and leisure suits were really cool. There was double digit unemployment, double digit inflation and the minimum wage (if you could get a job) was $2.25 per hour. There were extreme fuel shortages on gasoline that cost .65 to .80 per gallon. If you look at wages compared to the cost of gasoline then to what was last years hike in gas prices; it was child's play last year. The only insurance people had was Medicare which paid 80% of $8.00 after as I recall a $100 deductible. So, my income source consisted of those folding dead presidents. Them old farmers would take out their wallets and peel off 3 Lincolns to pay for my $15.00 adjustment…and were glad to do it. My entry fee (exam & x-rays) was $100.00 cash, none of them fancy new credit card things that take a percentage of your fee.

Know this chiropractor, “governments (be they federal, state, city or professional) will not solve your problems.” President Carter was a good man but a lousy president. I think the worst part of his time in office was when he let 52 U.S. diplomats and their US Marine guards continue to be held hostage for 444 days from November 4, 1979 to January 20, 1981 in the American embassy in Iran. If you don’t recall, a group of crazy Iranian students took over the US embassy in support of the Iranian revolution and Mr. Carter just couldn't’t seem to get our people rescued. There was an extreme lack of confidence in every conceivable realm of America at the time. Thank the Lord there was no Internet, CNN or talk radio to continually tell the American people how horrible life was during that time. Regardless of the disheartening times in America, my yearly take home pay in this little farming town in 1979 until early 1983 was between a low of a little over $52,000 (1979) to a high of a little under $120,000 (1982). I had a number of fine DC’s who gave me the same kind of direction that I give you now. I sold the practice in April of 1983 for ten times more than I bought it for in July of 1978. After that I moved on to new exploits in multiple clinics.

So what’s the answer? First you have to understand the three inner voices that hold you back anytime you do something to stimulate growth and success in your clinic. Also, the role they play when you talk yourself out of doing something to stimulate growth in your clinic. Once again, these are the ingrained notions or what you routinely think in your own mind when something positive begins to happen. Now hold on tight Bones here we go.

Evil Inner Voice #1. “It is too good to be true.” A lot of people get stopped right here with this thought. I really do feel that someone will self-sabotage their progress simply because of some doubt in themselves. It should not be surprising that the average teenager has heard, “you can’t do it” over 100,000 times. DC’s often think, “why should I even try to improve this turkey of a clinic, nothing good is ever going to happen to me anyhow, I think I’d rather do something else anyway.” To that I say this, people are amazed at my two children. They have accomplished some pretty great things in their short lives. Much of the reason for this is that my wife and I never told them they could not do something. We always directed them to great accomplishment. We were there when they fell to help them up and we would not let them give up on something that they had started. It has been said that 80-90% of our ‘self-talk’ is of a negative nature. That has to change to see those dreams we all have come to pass. I highly recommend the following book to get you on the road to overcoming self-doubt. What To Say When You talk To Yourself by Shad Helmstetter, PhD.D. You can get it on amazon.com.
Evil Inner Voice #2. “It will never last”. If you make it past Evil Inner Voice #1 this little booger is just waiting there to slap your happy butt back down to the floor of the chicken house. The powers of negativity love to see you rolling around in chicken (fill in the blank). Here’s another question. Why does it seem that patient interest in sending referrals, spinal care classes, advertisements or spinal screenings just seem to die after a short while? I’ll tell you why. Mainly because the DC has lost interest too and sadly lost interest first. Well then why do DC’s lose interest in something that is necessary to build the practice? Its not the program, Chiropractor. One word here…COMFORT. We all have at one time or another fell into the trap of getting comfortable with our surroundings. Because of this, we don’t continually aspire to see our dreams come to pass and become willing to settle for second best in life or even worse.
Another part of the comfort problem can be found in our inability to continually enjoy work. Work is not a curse. Work is a blessing that we should be grateful for at all times. King Solomon, the richest man in history (he makes Bill Gates look like a homeless guy) stated the following about work in Ecclesiastes 3:22. “Wherefore I perceive that there is nothing better, than that a man should rejoice in his own works; for that is his portion: for who shall bring him to see what shall be after him?” Wow…I wish my dad would have read that to me when I was watering his tomato garden in 100 degree Missouri heat when I was ten years old. Indeed, it has been a lesson that only time and error has taught me.
I digress here momentarily. Some DC’s really must like it when times things are not going well because it gives them something to talk about to other negative people. Somewhat a poison laden pity party that is tempered with a moderate to severe form of financial hysteria. But then, you may say, “but if I truly do want a better practice and financial situation and are willing to work for it, why do I sometimes think that things will never last? It is because of the orneriest, no account, slime ball thought any DC could ever have go through their mind and it is Evil Inner Voice # 3 below.

Evil Inner Voice #3. “I’m not worthy.” This is the worst possible thing that can go through your mind. The way you feel about yourself and what you have to offer the public in the way of service WILL dictate your life in the clinic and at home. This doesn’t mean that you need to be an egotistical megalomaniac. It means that you must feel more and more worthy to receive what you want to see come to pass. Many DC’s (like me) came from poor backgrounds and had to kick, bite and scratch their way though school and finally into practice. They have many poor family members and friends from their past and do not want to leave them behind in any part of the relationship. Not a thing wrong with that Chiropractor. But those people with lower incomes often try to drag you down. When I drove away to my first practice in an old Ford Pinto station wagon and then came back to visit family and friends wearing expensive clothes and wheeling up in a new Cadillac…well I went from wearing a halo to horns in their eyes. My dad even seemed like he was a little put out with me. They didn’t know how to deal with the new Joe. They just needed to get over it and did. I did not want to go back to my own personal Egypt and be a slave to poverty. The lesson here….we must become and remain compassionate influencers not influencees.

Or maybe there is something you do in your practice that makes you feel uncomfortable or to lack confidence? I’m talking exams, diagnosis, treatment etc. CBPers are your post x-rays crap too often? Are you kidding yourself and thereby the patient on how really great they are doing? There is a reason this should end. This is a root of inferiority which translates into unworthiness. You will be found out if your are the purveyor of any degree of clinical baloney. Even if you do so unknowingly. Confidence and certainty based on legit science and art is where IT is at, my friend. If you have something that you feel you lack in clinically….go study with someone who is good at it and get rid of it!! FTL, Chiropractor. FTL is an expression my son uses. It means “For The Love (of God).”

Okay, now we are more serious on this one. Maybe there is something else in your personal life that happened when you were younger that makes you feel bad about yourself. Hey, let’s be real. We ALL have our wounds from the past. If you want to truly become the DC you can be, you must confront those issues and move forward. Ignoring something only lets it grow deeper and stronger. It must be uprooted and the wound must be healed. Pointer…it all begins with forgiving others and taking the high road. I highly recommend a great book to start you on that journey. Wild At Heart by John Eldredge. I warn you though….this will mess with your mind but you will be better off for it. It was written for men but is applicable to ladies that are DC’s as well in my opinion.

The second half to the answer is this….while you are eliminating those 3 evil voices in your noggin (not after you have vanquished them) you have to set goals with deadlines and develop a plan to get there. Hang on to this idea…. “to succeed I must avoid being a wandering generality and I will become a meaningful specific”. Goals with deadlines and plans will do that as you eliminate your evil voices. Know your business Chiropractor. Enough said.

Lastly, Ronald W. ‘Ronaldus Magnus’ Reagan was elected after Jimmy Carter. The Reagan Presidency began in a dramatic manner: as Reagan was giving his inaugural address, the 52 U.S. hostages and Marines, held in Iran for 444 days were set free. Nobody was going to mess with the smilin’ cowboy who once worked for B.J. Palmer. So in closing, ask yourself this question, “in my current position, should I take the attitude of a gentleman peanut farmer (Carter) or a swaggering cowboy (Reagan)?” It’s your choice.

God bless you Chiropractor. Joe B DC

PS: I think that if there is one scripture that every DC in America should read and know; it is the following from Isiah 61. It is my desire that the anointing you have (even if you do not know what an anointing is) comes quickly to its fullness as you strive to be all my Lord made you to be.
Isaiah 61: Announce Freedom to All Captives

The Spirit of God, the Master, is on me because God anointed me.
He sent me to preach good news to the poor, to heal the heartbroken, announce freedom to all captives, to pardon all prisoners. God sent me to announce the year of his grace — a celebration of God's destruction of our enemies — and to comfort all who mourn. To care for the needs of all who mourn (in your city), giving them bouquets of roses instead of ashes, messages of joy instead of news of doom, a praising heart instead of a languid spirit.

Wisdom of the Samurai

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Wed, 11 Feb 2009 20:00:00 +0000

In discussion with a client recently, I shared with him my respect for Japanese culture. I mentioned I had found"The Book of Five Rings" by Miyamoto Musashi to have many great ideas for life today. This book was originally written 350 years ago, yet like many timeless works is relevant to our day to day life in an amazingly contemporary way.

We are living in a challenging time. We must play offense to succeed. That is a constant. However, we must also do this with honor. With that, I offer this summary of points from the undefeated swordsman to apply today.

1. Think of what is right and true.
2. Practice and cultivate the science.
3. Become acquainted with the arts.
4. Know the principles of the crafts.
5. Understand the harm and benefit of everything.
6. Learn to see everything accurately.
7. Become aware of what is not obvious.
8. Be careful even in small matters.
9. Do not do anything useless.

These points are from "The Earth Scroll" section. The Thomas Cleary translation edition 1993 Barnes and Noble Books, Inc.

The concept, become familiar with your environment, and focused on what is important and relevant. Play your game, no one else's...

Success in 2009

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Sun, 04 Jan 2009 21:47:00 +0000

As we begin 2009, we first must be grateful for all we have. Not so much the material things, as they are often of transient interest, and of course, superficial. Rather, we must be, and remain grateful for the talents we possess, the true friends we share, and the multitude of opportunities available to us as we look forward to 2009.

I was blessed again in late 2008 with the birth of my second son, Augustine Paul. When I hold him, or watch him with his mother, sisters or brother, I observe him changing, growing and learning daily. It is inspiring to me to consider my responsibility to him and to his siblings, and in another way; to follow his example, and be inquisitive, learning something new at every opportunity. Committing to life-long learning is one key element in setting the stage for success. I vow to learn something new every day from this point forward. Not a new "resolution" for me, just an affirmation to remember.

As I look forward to making a difference in 2009, I know I will continue to glean inspiration from those around me, my family, friends, colleagues, mentors and clients. The exchange of inspiration is made possible by first being grateful for them, and then recognizing their unique gifts, talents and humanity. In so doing, we all can help on another as we travel the path ahead.

I am optimistic for a good year. I know our country faces unique challenges. However, I am confident that each individual striving for success in an honest, grateful and diligent way will be the key to setting the country on a positive track.

Open, or not...focus is ESSENTIAL!

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Sat, 09 Aug 2008 18:50:00 +0000

This in from the ethers...

Dear Dr. Heun,

Four recent incidents led to the subject title of this e-mail. A couple of months ago I was adjusting a patient when my wife came in with my kids. My three and a half year old son came running up to me to tell me all sorts of things. I gave him a hug, went back to adjusting my patients and he continued to ask me things as I was adjusting, I became distracted and adjusted the wrong segment or side. The patient was ok, but I should have used the warning better.

Also a couple of months ago, a patient dropped out of my practice and when asked why said she wanted another opinion and was uncomfortable with kids running around the office and the lack of privacy.

About a week ago I was adjusting a patient who was dizzy several times after cervical adjusting and we had agreed I would not adjust her neck. After being distracted, dealing with patients on traction, I looked at her chart, saw her posture diagrams and adjusted her neck accordingly. I have not seen her since.

Two days ago I saw a new patient. His side view cervical showed a grade I anterolisthesis along with 27 degrees of extension of C6 on C7. There was a slightly reversed curve at C3-4 and only 3 degrees of extension in the rest of his neck. Of course I would not adjust him without numerous motion views to determine degree of instability, and may not at all. But it occurred to me if I was to adjust him and became distracted, I could do serious damage.

I have decided on the following steps:

1. Speak to staff, wife, kids and parents in my practice about minimizing distractions and the importance of my being able to focus to give the patient on the table all my attention.

2. When I do have to deal with someone on traction and return to adjusting, take a moment to refocus, read the chart carefully and be present with the patient.

3. Teach my staff how to take people off traction.

4. Send my unstable patient for a neurosurgical consult after taking motion views.

Do you have any other thoughts on handling these problems?

My answer was...

Good suggestions all. Laser beam focus is MANDATORY! For those doctors that have challenges multitasking, open adjusting is a bad idea.

Never adjust a patient unless your focus is completely on the patient you are adjusting.

Also...

The team you assemble must revere the adjustment as well as respect it. The correct application of forces into the human frame has the potential to initiate wonderful positive changes. The wrong application or poorly delivered adjustment can do immeasurable harm. Furthermore, the more focused the doctor applying the force, and visualizing the adjustment, the better the correction. After all, adjusting is a physical skill not unlike other precision athletic actions; golf shots and putting, tennis, billiards. The visualization and focus component makes all the difference.

If you are routinely distracted, make whatever changes you must immediately...the price is too high not to.

SJH

Handling the big gulp patient...

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Fri, 11 Jul 2008 16:21:00 +0000

Often patients have lifestyle habits that are detrimental to their overall health...the pace with which you handle these issues is critical to the doctor-patient relationship.

So this week a patient came in with a "super gulp" or whatever they are called, cup of soda. (Not too out of the ordinary) The thing that gets me scratching my head is this is my financial hardship patient, with Hx of cancer, fibromyalgia, and enough stress for both of us. She left the office and 5 minutes came back and had a look of relief as she held up her cup and said "almost forgot it."
Now- am I over the top...maybe. But it gets me thinking- How many of my patients are going to be coming to me for headaches and never tell me they drink a 6 pack a day of coke? or worse, those "energy drinks" that have 5 times the caffeine. Or whatever the scenario.
Anyway, I have attempted to create a general survey that a person will feel comfortable answering honestly and yet asks the questions that are pertinent. if there are more you can think of or if you think they are too vague or whatever, please feel free to fill me in.

I like the concept of going beyond the norm it is in keeping with being more like Sherlock Holmes than Dr. Watson...

"Never trust to general impressions, my boy, but concentrate yourself upon details. My first glance is always at a woman's sleeve. In a man, it is perhaps better to take the knee of the trouser."
A Case of Identity
Sherlock Holmes to Dr. Watson

"By a man's finger-nails, by his coat-sleeve, by his boots, by his trouser-knees, by the callosities of his forefinger and thumb, by his expression, by his shirt-cuff - By each of these things a man's calling is plainly revealed. That all united should fail to enlighten the competent inquirer in any case is almost inconceivable."
A Study in Scarlet
Sherlock Holmes to Dr. Watson

I used to have patients keep track of everything they put in their mouths, or smoked, snorted or injected (I think this about coveres it...) The reason for the injected and snorted is that I neglected these questions until I had a 35 year heroin addict tell me I should ask about injecting junk...I broadened my viewpoint from that point on, and of course added the snorting part too...;-)

Don't forget though, if you asked this woman if she cared about her health, she would say OF COURSE!

Patient ignorance...not stupidity. Everyone makes choices...be sure never to prejudice your patient care by judging...a variation of the proverbial chip...

How to handle/implement your form.

Health and Wellness Survey

How many glasses of water do you drink a day? 1 2 3 4 5 6 7 8 9 10 10+

How many cans of soda do you drink a day/week (circle one)? 0 1 2 3 4 5 6 6+

What else do you drink in an “average day”? _________________________________

How many fresh fruits do you eat a day/week (circle one) (ex. apple, banana, orange)? 1 2 3 4 5 5+

How many fresh vegetables do you eat a day/week (circle one) (ex. carrot, broccoli florets, corn on the cob)? 1 2 3 4 5 5+

For you, what is your “average” breakfast? ___________________________________________

How many hours do you sleep a night? 4 5 6 7 8 9 9+

On an “average day” how long do you go without getting up from a seated position? 1 2 3 4 5 5+

How many days out of an “average” week do you feel “stressed” 1 2 3 4 5 6 7

What do you do to relieve stress? Eat Drink (what?)________ Exercise (what?)_______

other__________________________

What part of the day do you most look forward to? __________________________________

What part of the week do you most look forward to? _________________________________

How would you describe your general state of health? ________________________________

Remember you must first give them what they want in order to create the opportunity to provide them with what they need. Therefore, do not complicate things by overloading people with too much up front...allow the reservoir of trust to build up a bit. Changing someone's health paradigm takes time...

Have the patient fill out this form at the first re-evaluation rather than on the first visit...

Review the results with the patient during their visits...how does their lifestyle impact their condition? Nothing generic, all of it should be direct and focused, and personally relevant.

Do not feed patients with a firehose...as the doctor patient relationship builds, you can do more and more, and truely have a positive impact upon the life and health of each patient you serve...

Insurance adjuster drops in for a visit...

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Thu, 10 Jul 2008 14:53:00 +0000

This just in from a Client out East...

Good Morning!
I just had a GEICO insurance adjuster enter my office to have a tour and to take pictures of my office, equipment, license and diploma. Oh, and sign in sheets. She is investigating a claim of patient who was rear-ended and who's vehicle had little damage, but she had significant damage to her body. I allowed her to take pictures of my xray room and the exam room, but I had patients so none could be taken in the office. She also commented on what a nice office it was and my xray equipment was better than most she had seen. I quoted some research about rear -impact damage and how it can't be related to soft tissue/ structural damage in conversation.
She questioned a few things on my bill including an after hour charge ( I saw the patient on a Friday because she was hit on a Thursday night).
Any thoughts on how to handle that in the future? This is the first time that's ever happened.

My response...

First of all, I recommend not having sign in sheets. An NCR (carbonless two ply copy) fee ticket makes much more sense, as then there is no opportunity for anyone (such as an IRS agent or Insurance Adjuster) to obtain information about how busy you are. You can simply provide information relevant to the patient in question rather than your entire daily patient list. Also once they have those patients names, is it reasonable that they may want to subpoena other patients to testify what occurred routinely in the office when they were there? Bills and or charges to compare? They (adjusters) like to have information from sign in sheets so that they can compute your average time spent per patient to see if it jives with your charges. Get rid of the sign in sheet, order your fee tickets (I presented this at the Milwaukee seminar...(email me at drsjh@drscottheun.com for links to order.)

You could have refused the photos of the sign in sheet, and for that matter made the person schedule an appointment to come back at a more convenient time, when patients are not in the office, I HIGHLY recommend this practice in the future. Do not let them have free reign, you do not have to. Set the game up by YOUR rules...do not let them intimidate you, or show up unannounced.

Only answer questions that are asked, do not offer anything else...be cordial, yet firm, this is YOUR place of business. If you have a signed contract with an insurance company, you may find that you have to allow spontaneous visits...but if you DON'T have a contractual arrangement, this does not apply. They have no legal authority to come into your place of business and investigate in most instances. Being cooperative is important, but being a pushover is not.

I am not sure about the after hours charge, however it seems reasonable to me, you do not normally have hours at that time. However, that said, you may want to review the code on this point to see what the stipulations are exactly.

SJH

Welcome to my new blog!

drsjh@chiropracticementoring.com (Dr. Scott J. Heun) — Wed, 10 Oct 2007 19:34:00 +0000

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